Acute Kidney Injury

Question 1

What form of renal disease is commonly seen in children?

Answer 1

Nephrotic syndrome

Question 2

Which triad is associated with nephrotic syndrome?

Answer 2

Proteinuria (>3g/day)
Hypoalbuminaemia
Oedema

Question 3

Does nephrotic syndrome always affect renal function?

Answer 3

No, can have normal function.

Question 4

Which 4 signs are associated with nephritic syndrome?

Answer 4

Oliguria
Oedema
Hypertension
Active urinary sediment

Question 5

What commonly precedes the development of nephritic syndrome?

Answer 5

Infection

Question 6

What is an AKI?

Answer 6

An abrupt reduction in kidney function.

Question 7

What are the 3 diagnostic criteria for an AKI?

Answer 7

An absolute increase in serum creatinine by >26.4umol
An increase in creatinine by 50%
A reduced urine output

Question 8

What are the 3 categories of AKI?

Answer 8

Pre-renal
Renal
Post-renal

Question 9

What is the issue in those with a pre-renal AKI?

Answer 9

Reduced renal perfusion

Reversible if cause mitigated.

Question 10

What may cause pre-renal AKI?

Answer 10

Hypovolaemia
Hypotension
Medications
Hepatorenal syndrome

Question 11

Which medications may cause pre-renal AKI?

Answer 11

NSAIDs
ACE inhibitors
ARBs
Aspirin

Question 12

What is hepatorenal syndrome?

Answer 12

AKI in the context of established liver disease.

A pre-renal form of AKI.

Question 13

What is defined as oliguria?

Answer 13

A urine output of less than 0.5ml/kg/hr.

Question 14

Is raised creatinine normal when taking an ACE inhibitor?

Answer 14

Yes - a normal response.

Beware vomiting/diarrhoea alongside this as it indicates volume depletion, and thus reduced GFR.

Question 15

What may result if a pre-renal AKI goes untreated?

Answer 15

Acute tubular necrosis

Question 16

What is the most common form of AKI in a hospital setting?

Answer 16

Acute tubular necrosis

Question 17

What may cause acute tubular necrosis?

Answer 17

Sepsis
Severe dehydration
Rhabdomyolysis
Drug toxicity

Question 18

How should a pre-renal AKI be managed?

Answer 18

Assess hydration level
Provide fluid challenge

Question 19

What produces a renal AKI?

Answer 19

A disease resulting in inflammation/damage to cells.

Can be sub-divided with respect to the structure affected.

Question 20

What is the primary cause of AKI?

Answer 20

Vasculitis

Question 21

What may cause interstitial nephritis?

Answer 21

Drugs
Tuberculosis
Sarcoidosis

A form of renal AKI.

Question 22

Which medications may cause interstitial nephritis?

Answer 22

Penicillin
PPIs
NSAIDs

Question 23

What may cause tubular injury?

Answer 23

Drugs (e.g. gentamicin)
Contrast
Rhabdomyolysis

A form of renal AKI.

Question 24

In those with AKI, what does the presence of haematuria suggest?

Answer 24

Renal causation.

Question 25

What are the 5 life-threatening complications of AKI?

Answer 25

Hyperkalaemia Fluid overload (resistant to diuretics) Severe acidosis Uraemic pericarditis/pericardial effusion Severe uraemia (>40)

Question 26

What is responsible for a post-renal AKI?

Answer 26

Urological tract obstruction

Question 27

What are plausible causes of urological tract obstruction?

Answer 27

Stones Malignancy/Tumor Strictures Extrinsic pressure Retention

Question 28

Following obstruction, what is a response to be aware of?

Answer 28

Polyuria Beware this, as may need fluid replacement.

Question 29

What is defined as life-threatening hyperkalaemia?

Answer 29

>6.5 If any hyperkalaemia seen, perform an ECG.

Question 30

How is hyperkalaemia managed?

Answer 30

10ml of 10% calcium gluconate IV over 2-3 mins - will protect the myocardium. Insulin (to move K+ back into cells) 50ml 50% dextrose Salbutamol nebuliser

Question 31

Is calcium resonium used in management of acute hyperkalaemia?

Answer 31

No, mechanism involves inhibiting absorption through the GI tract, therefore more suited to chronic cases.

Question 32

What are urgent indications to perform haemodialysis?

Answer 32

Life-threatening/Unresponsive hyperkalaemia Severe acidosis Fluid acidosis Uraemia with pericarditis/pericardial effusion

Question 33

Do patients taking ACE inhibitors have sick day rules?

Answer 33

Yes, do not take if have diarrhoea/vomiting. May precipitate pre-renal AKI.